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General NPI Number Information
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NPI Number | 1063794279
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Entity Type | Individual
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Provider Name | HEATHER DAVENPORT MA, LMFT#101616
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Gender | Female
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 202 GLACIER DR FL 2
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City | MARTINEZ
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State | CA
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Zip | 94553
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Country | US
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Telephone | 925-957-5306
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Fax | 925-957-2746
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Provider Business Mailing Address
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Address Line | 513 VALLEY VIEW CT
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City | MARTINEZ
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State | CA
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Zip | 94553-3562
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Country | US
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Telephone | 925-957-5306
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 73583
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT101616
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License Number State | CA
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